Provider Demographics
NPI:1154843886
Name:WADE, KATHERINE E
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:E
Last Name:WADE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 TALCOTT FOREST RD APT H
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06032-3574
Mailing Address - Country:US
Mailing Address - Phone:860-268-5615
Mailing Address - Fax:
Practice Address - Street 1:50 WASHINGTON ST STE 502
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06854-2755
Practice Address - Country:US
Practice Address - Phone:888-355-3255
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-14
Last Update Date:2017-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X
CT009235225100000X
CT9235225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist